COVID Vaccine Business Inquiry Form
Nevada County Public Health wants to make vaccine accessible to all. Part of that effort is to bring vaccine to you. If your business would like to request a COVID vaccine event at your location, or at a Public Health location, please complete the form below.
After you fill out this form, your information will be reviewed and you will be contacted by our outreach team to make further arrangements. Depending on demand, certain types of business may be prioritized for on-site vaccination. We will do our best to serve everyone interested in vaccination.
For general COVID questions, contact 211 by dialing 2-1-1 or 1-833-DIAL211. You can speak with a local call agent 24/7 in English or Spanish.
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Primary contact's name (first and last)
Primary contact's email address
Primary contact's phone number
Eastern Nevada County (Truckee and surrounding area)
Western Nevada County (Nevada City/Grass Valley and surrounding area)
What best describes your business/organization?
Agriculture and farming
Cannabis (other than farming)
Childcare or afterschool care
Restaurant, bar or food service
Tree cutting or landscaping
Other (please describe below)
If you selected "Other," please briefly describe your business/organization
Total number of staff
Number of staff you anticipate would like to be vaccinated on-site
What percentage of those staff speak Spanish as a first language?
Would any of your staff require accommodations (for instance, to accommodate a disability)? If so, what kind of accommodations?
Any additional information you'd like to share?
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